Which medications in the drug class Anticholinergic agents are used in the treatment of Organophosphate Toxicity?

Updated: Dec 31, 2020
  • Author: Kenneth D Katz, MD, FAAEM, ABMT; Chief Editor: Sage W Wiener, MD  more...
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Anticholinergic agents

These agents act as competitive antagonists at the muscarinic cholinergic receptors in both the central and the peripheral nervous system. These agents do not treat nicotinic effects.

Atropine IV/IM (Isopto, Atropair)

Initiated in patients with OP toxicity who present with muscarinic symptoms.

Competitive inhibitor at autonomic postganglionic cholinergic receptors, including receptors found in GI and pulmonary smooth muscle, exocrine glands, heart, and eye.

The endpoint for atropinization is dried pulmonary secretions and adequate oxygenation. Tachycardia and mydriasis must not be used to limit or to stop subsequent doses of atropine. The main concern with OP toxicity is respiratory failure from excessive airway secretions.

Glycopyrrolate (Robinul)

Indicated for use as an antimuscarinic agent to reduce salivary, tracheobronchial, and pharyngeal secretions. Does not cross the blood-brain barrier. Can be considered in patients at risk for recurrent symptoms (after initial atropinization) but who are developing central anticholinergic delirium or agitation.

Since glycopyrrolate does not cross BBB, it is not expected to control central cholinergic toxicity. Bird et al suggested that atropine (rather than glycopyrrolate) was associated with lower, early OP-induced mortality

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